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Foreign animal disease (FAD) outbreaks can have devastating impacts, but they occur infrequently in any specific sector anywhere in the United States (US). Training to proactively discuss implementation of control and prevention strategies are beneficial in that they provide stakeholders with the practical information and educational experience they will need to respond effectively to an FAD. Such proactive approaches are the mission of the Secure Food System (SFS; University of Minnesota; St. Paul, Minnesota USA).

Methods

The SFS exercises were designed as educational activities based on avian influenza (AI) outbreaks in commercial poultry scenarios. These scenarios were created by subject matter experts and were based on epidemiology reports, risk pathway analyses, local industry practices, and site-specific circumstances. Target audiences of an exercise were the groups involved in FAD control: animal agriculture industry members; animal health regulators; and diagnosticians. Groups of industry participants seated together at tables represented fictional poultry premises and were guided by a moderator to respond to an on-farm situation within a simulated outbreak. The impact of SFS exercises was evaluated through interviews with randomized industry participants and selected table moderators. Descriptive statistics and qualitative analyses were performed on interview feedback.

Results

Eleven SFS exercises occurred from December 2016 through October 2017 in multiple regions of the US. Exercises were conducted as company-wide, state-wide, or regional trainings. Nine were based on highly pathogenic avian influenza (HPAI) outbreaks and two focused on outbreaks of co-circulating HPAI and low pathogenicity avian influenza (LPAI). Poultry industry participants interviewed generally found attending an SFS exercise to be useful. The most commonly identified benefits of participation were its value to people without prior outbreak experience and knowledge gained about Continuity of Business (COB)-permitted movement. After completing an exercise, most participants evaluated their preparedness to respond to an outbreak as somewhat to very ready, and more than one-half reported their respective company or farms had discussions or changed actions due to participation.

Conclusion:

Evaluation feedback suggests the SFS exercises were an effective training method to supplement preparedness efforts for an AI outbreak. The concept of using multi-faceted scenarios and multiple education strategies during a tabletop exercise may be translatable to other emergency preparedness needs.

Since 2006, Israel has been confronting an outbreak of carbapenem-resistant Enterobacteriaceae (CRE), and in 2007 Israel implemented a national strategy to contain spread. The intervention was initially directed toward acute-care hospitals and later expanded to include an established reservoir of carriage in long-term-care hospitals. It included regular reporting of CRE cases to a central registry and daily oversight of management of the outbreak at the institutional level. Microbiological methodologies were standardized in clinical laboratories nationwide. Uniform requirements for carrier screening and isolation were established, and a protocol for discontinuation of carrier status was formulated. In response to the evolving epidemiology of CRE in Israel and the continued need for uniform guidelines for carrier detection and isolation, the Ministry of Health in 2016 issued a regulatory circular updating the requirements for CRE screening, laboratory diagnosis, molecular characterization, and carrier isolation, as well as reporting and discontinuation of isolation in healthcare institutions nationwide. The principal elements of the circular are contained herein.

Social disability is a hallmark of severe mental illness yet individual
differences and factors predicting outcome are largely unknown.

Aim

To explore trajectories and predictors of social recovery following a
first episode of psychosis (FEP).

Method

A sample of 764 individuals with FEP were assessed on entry into early
intervention in psychosis (EIP) services and followed up over 12 months.
Social recovery profiles were examined using latent class growth
analysis.

Results

Three types of social recovery profile were identified: Low Stable (66%),
Moderate-Increasing (27%), and High-Decreasing (7%). Poor social recovery
was predicted by male gender, ethnic minority status, younger age at
onset of psychosis, increased negative symptoms, and poor premorbid
adjustment.

Conclusions

Social disability is prevalent in FEP, although distinct recovery
profiles are evident. Where social disability is present on entry into
EIP services it can remain stable, highlighting a need for targeted
intervention.

Early intervention services (EIS) comprise low-stigma, youth-friendly mental health teams for young people undergoing first-episode psychosis (FEP). Engaging with the family of the young person is central to EIS policy and practice.

Aims

By analysing carers' accounts of their daily lives and affective challenges during a relative's FEP against the background of wider research into EIS, this paper explores relationships between carers' experiences and EIS.

Method

Semi-structured longitudinal interviews with 80 carers of young people with FEP treated through English EIS.

Results

Our data suggest that EIS successfully aid carers to support their relatives, particularly through the provision of knowledge about psychosis and medications. However, paradoxical ramifications of these user-focused engagements also emerge; they risk leaving carers' emotions unacknowledged and compounding an existing lack of help-seeking.

Conclusions

By focusing on EIS's engagements with carers, this paper draws attention to an urgent broader question: as a continuing emphasis on care outside the clinic space places family members at the heart of the care of those with severe mental illness, we ask: who can, and should, support carers, and in what ways?

Patients hospitalized in post-acute care hospitals (PACHs) constitute an important reservoir of antimicrobial-resistant bacteria. High carriage prevalence of carbapenem-resistant Enterobacteriaceae (CRE) has been observed among patients hospitalized in PACHs. The objective of the study is to describe the impact of a national infection control intervention on the prevalence of CRE in PACHs.

Design

A prospective cohort interventional study.

Setting

Thirteen PACHs in Israel.

Intervention

A multifaceted intervention was initiated between 2008 and 2011 as part of a national program involving all Israeli healthcare facilities. The intervention has included (1) periodic on-site assessments of infection control policies and resources, using a score comprised of 16 elements; (2) assessment of risk factors for CRE colonization; (3) development of national guidelines for CRE control in PACHs involving active surveillance and contact isolation of carriers; and (4) 3 cross-sectional surveys of rectal carriage of CRE that were conducted in representative wards.

Results

The infection control score increased from 6.8 to 14.0 (P < .001) over the course of the study period. A total of 3,516 patients were screened in the 3 surveys. Prevalence of carriage among those not known to be carriers decreased from 12.1% to 7.9% (P = .008). Overall carrier prevalence decreased from 16.8% to 12.5% (P = .013). Availability of alcohol-based hand rub, appropriate use of gloves, and a policy of CRE surveillance at admission to the hospital were independently associated with lower new carrier prevalence.

Conclusion

A nationwide infection control intervention was associated with enhanced infection control measures and a reduction in the prevalence of CRE in PACHs.

Interventions to reduce treatment delay in first-episode psychosis have met with mixed results. Systematic reviews highlight the need for greater understanding of delays within the care pathway if successful strategies are to be developed.

Aims

To document the care-pathway components of duration of untreated psychosis (DUP) and their link with delays in accessing specialised early intervention services (EIS). To model the likely impact on efforts to reduce DUP of targeted changes in the care pathway.

Method

Data for 343 individuals from the Birmingham, UK, lead site of the National EDEN cohort study were analysed.

Results

A third of the cohort had a DUP exceeding 6 months. The greatest contribution to DUP for the whole cohort came from delays within mental health services, followed by help-seeking delays. It was found that delay in reaching EIS was strongly correlated with longer DUP.

Conclusions

Community education and awareness campaigns to reduce DUP may be constrained by later delays within mental health services, especially access to EIS. Our methodology, based on analysis of care pathways, will have international application when devising strategies to reduce DUP.

The temperature dependent structural evolutions of RbxC60 (x = 3, 5, 6) and K4C60 were studied using both in-house andsynchrotron x-ray powder diffraction and thermal analysis techniques over a temperature range of 10K - 673K. The superconducting face centered-cubic (fcc) Rb3C60 and the body centered-tetragonal (bct) M4C60(M = K, Rb) phases are found to be line compounds in this temperature range, while the body centered-cubic (bcc) phase forms a solid solution in which the solubility of vacant M sites increases with temperature. The orientation of the C60 molecules in the K4C60 phase was analyzed. A crystalline fcc Rb1C60 phase is stable only above room temperature.

The pyrolytic conversion of an organosilsesquioxane (Owens-Illinois resin GR650) to SiO2 is characterized by ir spectroscopy, thermogravimetry and evolved gas analysis (line-of-sight mass spectroscopy). Scanning calorimetry, ramping at 10°C/min, on the as-received (room temperature annealed) resin indicates a glass transition temperature of 67°C which decreases to 58°C for an unrelaxed sample. The ir spectra have bands which can be assigned to Si-CH3 and Si-O-Si modes. For 30 minute isothermal anneals at temperatures above 420°C there is a continuous decrease in the bands associated with the Si-CH3 groups such that after 30 minutes at 650°C the ir spectrum has evolved to that for SiO2. Evolved gas analysis indicates that there are four major components evolving. Over the temperature range (ramping at 10°C/min) ∼180 to ∼500°C we observe C2H5OH and H2O, both of which are condensation reaction products from the curing reaction. Methane is a major evolving species over the temperature range ∼500 to ∼800°C and the thermal spectrum is double peaked which we attribute to CH3+ bound to the inside and outside of the polymer cage structures. The final major component detected was H2, over the temperature range ∼600 to ∼1100°C, which was attributed to pyrolysis of the organic components, both trapped and evolving. The features of the weight loss curve can be accounted for by the measured evolving species spectra.

The electronic properties of arrays and isolated magnetite nanocrystals were studied using tunneling spectroscopy. Macroscopic tunnel junctions were used to study stacked arrays of the nanocrystals. The temperature dependent resistance measurements showed an abrupt increase of the resistance around 100 K, attributed to the Verwey metal-insulator transition, while the current-voltage characteristics exhibit a sharp transition from an insulator gap to a peak in the density of states near the Fermi energy. This conductance peak was sensitive to in-plane magnetic field showing large magnetoresistance. The tunneling spectra obtained on isolated particles using a Scanning Tunneling Microscope exhibit a gap-like structure below the transition temperature that gradually disappeared with increasing temperature, ending with a small peak structure around zero bias.

To determine the rates of and risk factors for carriage and acquisition of extended-spectrum (β-lactamase (ESBL)-producing Enterobacteriaceae during hospitalization.

Design.

Cohort study.

Setting.

Shaare Zedek Medical Center, a 550-bed teaching hospital.

Methods.

During a 5-month period (February 1-June 30, 2004), 167 (8%) of 1,985 newly admitted general medical patients were enrolled in our study. Nasal, oropharyngeal, and rectal swab specimens were obtained at admission and every 2-3 days until hospital discharge or death. Enterobacteriaceae isolates were tested for ESBL, and Staphylococcus aureus isolates were tested for methicillin resistance.

Rectal carriage of ESBL-producing Enterobacteriaceae occurred in 13 (8%) of 167 patients at admission to the medical departments of our hospital and in 4 (33%) of 12 patients still remaining in our hospital after 2 weeks.

Background: Diseases of the lungs and airways can be life-threatening in patients with congenital cardiac disease. External compression, and tracheobronchomalacia, as well as pathology of the large airways, can cause respiratory symptoms such as wheezing, stridor, fever, and dyspnoea, along with producing difficulty to wean the patient from mechanical ventilation. A definite diagnosis may be achieved by fibreoptic flexible bronchoscopy. Aims: To characterize the patients who underwent bronchoscopy for respiratory diseases associated with congenital cardiac disease, and to evaluate the safety, total diagnostic rate, and diagnostic rate, which yielded alteration of treatment in this group of patients. Methods: We reviewed retrospectively the records of 39 patients with congenital cardiac disease associated with abnormalities of the airways who underwent 49 fibreoptic bronchoscopies between 1999 and 2004. The patients were evaluated with regard to rate of diagnosis, the rate of procedures that resulted in alteration of management, and the rate of complications. Results: Fibreoptic flexible bronchoscopy was safe, and contributed to a specific diagnosis in almost nine-tenths of the procedures. A specific diagnosis that resulted in treatment alteration was achieved in one-fifth of the procedures. Conclusions: Fibreoptic flexible bronchoscopy has an important role in the evaluation of pulmonary abnormalities in patients with congenital cardiac diseases, and should be considered as an initial diagnostic tool that may guide the clinician with regard to the proper therapy.

From April to September 2004, we enrolled consecutive newly admitted patients who were hospitalized in beds adjacent to either mechanically ventilated patients or patients designated as “do not resuscitate” (DNR). For each of these patients, we also enrolled a control patient who was not hospitalized in a bed adjacent to a critically ill patient. We collected specimens from the anterior nares, the oral cavity, and the perianal zone at the time of admission and subsequently at 3-day intervals until discharge or death. Specimens were cultured on selective media to detect growth of antibiotic-resistant pathogens, including Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β lactamase (ESBL)–producing Enterobacteriaceae, and vancomycin-resistant enterococci (VRE).

In this pilot study, we did not detect an increased incidence rate of isolation of multidrug-resistant pathogens among patients hospitalized in beds adjacent to critically ill patients. Further studies with larger samples should be conducted in order to generate valid data and provide patients, physicians, and policy makers with a sufficient knowledge base from which decisions can be made.

From April to September 2004, we enrolled consecutive newly admitted patients who were hospitalized in beds adjacent to either mechanically ventilated patients or patients designated as “do not resuscitate” (DNR). For each of these patients, we also enrolled a control patient who was not hospitalized in a bed adjacent to a critically ill patient. We collected specimens from the anterior nares, the oral cavity, and the perianal zone at the time of admission and subsequently at 3-day intervals until discharge or death. Specimens were cultured on selective media to detect growth of antibiotic-resistant pathogens, including Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β lactamase (ESBL)–producing Enterobacteriaceae, and vancomycin-resistant enterococci (VRE).

In this pilot study, we did not detect an increased incidence rate of isolation of multidrug-resistant pathogens among patients hospitalized in beds adjacent to critically ill patients. Further studies with larger samples should be conducted in order to generate valid data and provide patients, physicians, and policy makers with a sufficient knowledge base from which decisions can be made.

Increasing numbers of children who have undergone intracardiac repair of tetralogy of Fallot have survived to adulthood, but often have residual haemodynamic and/or electrical abnormalities. We report the unusual observation of 4 instances of cerebrovascular accidents in young adults subsequent to surgical repair of tetralogy of Fallot.

To strengthen guidelines for vancomycin use, practical guidelines were developed. A prospective survey was conducted of all patients receiving vancomycin during two 1-month periods, 1 year apart, during which significant improvements were noted. Practical guidelines may contribute to appropriateness of vancomycin use, serve as educational tools, and facilitate improved surveillance.

To assess the practice of antimicrobial prophylaxis for surgical procedures in eight surgical departments in a 550-bed teaching hospital.

Methods:

A list of all major procedures performed in our hospital, with recommendations for prophylaxis based upon the literature, has been distributed since 1993 and is updated periodically. The practice of surgical prophylaxis between January 1 and March 31,1996, was examined by assessing four variables: (1) Did the particular procedure justify prophylaxis, and was it provided? (2) Was timing optimal, ie, within 1 hour prior to surgery? (3) Was the appropriate antimicrobial selected? (4) Was duration optimal, ie, ≤24 hours?

Results:

During the study period, 2,117 operations were performed, of which 1,631 (77%) were reviewed. Sixty-six percent were clean surgery, 28% clean-contaminated, and 6% contaminated; 72% of procedures were elective, 28% emergencies. Of 1,631 operations requiring prophylaxis, 1,142 (70%) received it, 489 (30%) did not. Of 1,631 patients, 1,392 (85%) received appropriate care: 929 (67%) appropriately received prophylaxis, and 463 (33%) appropriately did not receive prophylaxis. Of 955 patients who received prophylaxis, 26 (3%) did so inappropriately. Of 1,142 patients who should have received prophylaxis, 213 (19%) did not receive it. Female gender, clean surgery, elective operations, and infrequently performed procedures were all significant indicators of inappropriately withheld prophylaxis (P<.001). In addition, the rate of appropriately provided prophylaxis varied between departments from 71% to 97% (P<.001). Assessment of the 929 procedures for which prophylaxis was justified and given revealed that 100% of patients received it on time, the choice of antimicrobial was appropriate in 95% of cases, and duration was ≤24 hours in 91%.

Conclusions:

Audits of surgical prophylaxis are expected to detect different errors in different institutions. Conducting audits of surgical prophylaxis probably should be part of the routine activity of infection control teams. Feeding the information back to surgeons could improve adherence to recommended guidelines and might contribute to reduced wound infection rates.

A modular hierarchical model for controlling robots is presented. This model is targeted mainly for research and development; it enables researchers to concentrate on a certain specific task of robotics, while using existing building blocks for the rest of their applications. The presentation begins by discussing the problems with which researchers and engineers of robotics are faced whenever trying to use existing commercial robots. Based on this discussion we propose a new general model for robot control to be referred as TERM (TEchnion Robotic Model). The viability of the new model is demonstrated by implementing a general purpose robot controller.